What Is the Welsh Dental Pilot Programme? and Why Would I Want to Be Involved?

What is the Welsh Dental Pilot Programme? And why would I want to be involved?

The Welsh Pilot programme has been organised to test new systems of payment and delivery of dental services in Wales to find a system that will work for you!

We are looking at piloting systems which move away from UDAs and towards a system which focuses on tailored patient care based on risk assessment. The pilots should be beneficial for patients and fair for the dentist.

These pilots are an excellent opportunity for you to influence and test these proposed system’s with no financial risk to yourself or your practice.

What do we intend to do?

We have developed two pilots which are unique to Wales in addition to these pilots there may also be the opportunity to select from two pilots from the English models. Once England have decided upon their models we will identify which of these would be appropriate for use in Wales and we will provide more information on these to interested parties.

Closing date for submission of expressions of interest is Friday 20th August 2010

of 14 The Welsh Models we have selected are:

What is it and how will it work? What will you be asked to do? How will we evaluate it? Why would I want to take part in this pilot? This pilot tests a way of working addressing issues of You will be asked to participate in the Clear evaluation criteria will be finalised This pilot may be of access, quality and prevention. evaluation of the pilot, which may prior to the start of the pilot but it is particular interest to include a questionnaire and expected that the evaluation will include practices who see a lot of After working normally for one year your activity will participating in one or more focus stakeholder experiences of: patients from deprived be assessed by a contracts monitoring team who will groups.  Access to dental services areas and have found the be focusing on issues around access, quality and (patients numbers) current UDA system prevention. Using some key performance indicators  Quality of services, as measured difficult, or who want to which will focus on rewarding the treatment of by performance indicators try a new way of to Quality and deprived patients, continuing patient care and minimal  Delivery of oral health distribute UDAs. And outcome Pilot intervention. A formula will be applied to your contract promotion and prevention those practices who have activity which will calculate the number of UDAs  Cost of the pilot to stakeholders a lower than average UDA required to be delivered at your original contract  Information quality value. value.  Support and infrastructure of dental services A patient satisfaction survey will be carried out at the  Difficulty involved in the pilot start of the pilot period, and again at then end of the process second year.  Stakeholder satisfaction

This pilot involves changes to how you are paid to This pilot will be linked with the Clear evaluation criteria will be finalised This pilot may be of treat children. A capitation based payment system will Designed to Smile prevention prior to the start of the pilot but it is particular interest for be introduced for 0-18 year olds, underpinned by a programme. Practices undertaking this expected that the evaluation will practices who want to registration scheme with a variable additional payment pilot will need to have a nominated include: establish themselves as linked and weighted for local deprivation. team member who will spend 2 2 specially geared DRS visits annually, leaders in the prevention “induction” days with the CDS D2S three parent/patient satisfaction of dental disease. Preventive The funding received by your practice would be based team to learn about the programme questionnaire carried out pre, mid and Dental Care on your existing contract value which will be re- and methods of delivery, attend any end of the pilot the new child for Children modelled so that- relevant D2S training days and attend registrations will be monitored in terms and Young the bi-annual meetings with CDS staff. of numbers and deprivation score. Each a. a basic annual capitation fee is allocated for The principal provider, in the practice participating practice will be expected to People each child under care. will be expected to have biannual complete an annual report which will b. if any child fell into one of the two bands meetings with the D2S coordinator and include a record of all referrals for indicating they were resident in a more CDS clinical Director extractions under GA and the clinical deprived area then an enhanced supplement reason for these referrals, and a would be applied declaration that they have provided risk based preventive services to children. Full information on these pilots can be found at http://www.publichealthwales.org/welshdentalpilotprogramme/ How can I become a pilot?

If you are a contract holder and would like your practice(s) to be considered for piloting, please contact your LHB Dental Lead first (Appendix 1). If they are happy to support your application, you will need to complete the expression of interest proforma which you can find here: http://www.publichealthwales.org/welshdentalpilotprogramme/ You need to complete and submit this form electronically on the website.

If you would like any further information or have any questions please contact: Raylene Roper, Pilot Coordinator on 01495 332218 or [email protected]

Your usual LHB contact is the person to speak with regarding any interest in this pilot programme.

Selection process and timescales

Once expressions of interest have been received, we will send your dental contact at the Health Board a questionnaire which they will complete in discussion with you. A short listing panel meeting is set for the 21st September, where using the information provided in the questionnaire, the panel will make their decision on which applicants are best suited to the pilots.

Once the short listing has been completed the successful applicant will be informed of the panels’ decision. Unsuccessful applicants will be provided with feedback, if requested.

Successful applicants and their associated LHB dental lead will be expected to attend an in- depth briefing session.

Dental Provider commitments

 Providers must be willing to be flexible regarding data returns as data categories required for collection may change  Providers must be willing to participate in the evaluation process  Providers must be willing to participate in knowledge-sharing events and must be committed to sharing learning and providing honest feedback about their contractual arrangements with the Programme  All practices involved in the Welsh Dental Pilot will need to be computerised and capable of submitting electronic data returns to the Dental Services Division, all practices taking part in the Pilot MUST have an email address and internet access.

Please also read carefully the memorandum of understanding document (Appendix 2), the purpose of this document is to outline clearly the ways of working and the roles and responsibilities of participants involved in the Welsh Dental Pilot Programme.

What support you will receive

In return for the commitment offered by pilots, support provided by the Welsh Dental Pilot Programme will include:  Regular forums/network through which good practice can be captured and shared; and where you can receive advice and support on all aspects of the pilot.  You will have access to the Dental Public Health Website where you can log on to the specially created pages to read regularly updated project documents such as project status reports, updated times scales etc  We will produce and distribute a regular newsletter which will provide updates on all aspects of the pilots.  A Facebook group has been proposed and will be set up if pilot practice wish to use it.  1:1 contact through the programme team

Frequently asked Questions

The consultation sessions which have been held around Wales raised a number of pertinent questions, some of which we have answered in this briefing pack others we have outlined below.

This list of Q&A below is not exhaustive and we are happy to answer any questions you may have which are not answered below.

What are the benefits of being a pilot? The key benefit in being part of the Welsh Dental Pilot Programme is that it provides an opportunity for you to influence and contribute to the development of a truly oral health focused service. In addition to this, we also anticipate that being part of the Pilot network will enable participants to share ideas and good practice with other providers and LHBs.

Is there any additional funding available for undertaking a pilot? All Pilot clinical work will need to be financed within existing LHB budgets; however monies are available for Dentists to attend briefing and evaluation sessions.

Will participating in a pilot impact on IT systems, and will there be help for dentists? The Pilots may involve additional components to IT systems; work is currently being done with national software companies. If additional software is introduced for the pilots additional IT support will be provided.

How will the pilots be evaluated? The evaluation criteria will be developed before the start of the pilots and will take into account the work in England to evaluate the Steele Pilots. The evaluation will include a variety of perspectives from dentists, patients and the Health Boards. Academic Units will be invited to tender for this evaluation.

Would practices who take part in pilots be protected from disadvantage? The terms and conditions of the pilot will ensure that practices will not incur financial detriment from their participation in the Welsh Dental Pilot Programme.

How will you update us? In addition to regular forums or workshops we will be sending out regular newsletters to all GDS and PDS providers which will provide an update of the pilots and contain any relevant information. There will be dedicated pages on the Public Health Wales website which will be regularly updated and we are looking in to creating a discussion forum on this site as well as the possibility of creating a Facebook group which again will be updated regularly.

How long will the pilots run for? It is envisaged that the pilots will run for a total of 24 months (until April 2013), to allow as much time as possible to learn practical lessons from them.

What are the timescales for pilots? The Pilots are due to go live in April 2011. See detailed timescale Appendix 3.

of 14 Will being a Pilot affect overall contract value? No – the value of the contract remains as agreed between the provider and LHB who both hold the contract. Being a pilot does not affect this. The commitments involved in being a Pilot are outlined in the Memorandum of Understanding which can be found at Appendix 2.

Does being part of Welsh Dental Pilot Programme mean a lot of additional work? No – initially, we will only want to collect information which you will be collecting anyway. At a later date, we may ask for additional data items but we would discuss this first to ascertain whether it is feasible and reasonable. We will ask people to participate in evaluation activities, such as interviews or workshops, but we hope that you will find participating in this process helpful, informative and empowering.

What happens if I don’t want to be a pilot anymore? If you do not want to be a pilot anymore, we would encourage you to discuss the reasons for your request with your LHB and then with the Programme Team. If we are able to help in resolving any difficulties associated with being a pilot, we would be keen to do so.

Closing date for submission of expressions of interest is Friday 20th August 2010

Further information:

Web link - http://www.publichealthwales.org/welshdentalpilotprogramme/ Steele review link - http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance /DH_101137

Acknowledgments.

UDA Sub Group and focus group comprising of ; Alison Jones, Andrew Nourish, Ed Williams, Ellen Davies.

of 14 Appendix 1

BETS CADWALADR UNIVERSITY LHB Flintshire Paul Bowker Head of Primary Care Services - Flintshire Betsi Cadwaladr University Health Board Preswylfa, Hendy Road, Mold CH7 1PZ Tel/Ffon: (01352) 803225 e-mail: [email protected] Gwynedd Heather Merrick Primary Care Eryldon, Ffordd Campbell, Caernarfon LL55 1HU Tel/Ffon : 01286 674218 e-mail :[email protected] Conwy Tony Benton Princes Park, Princes Drive, Colwyn Bay, LL29 8PL Tel/Ffon; 01492 536586 e-mail: [email protected] Anglesey Sian Gruffydd 17 High Street, Llangefni, Ynys Mon LL77 7LT Tel/Ffon: 01248 751229 e-mail : [email protected] Denbigshire David Johnson Primary Care Matthew House, Llys Edmund Prys, St Asaph Business Park, St Asaph, LL17 0JA Wrexham Emlyn Roberts Dental Co-ordinator Betsi Cadwaladr University Health Board Tel: (01978) 346543 e-mail [email protected] ABERTAWE BRO MORGANNWG UNIVERSITY LHB Swansea Richard Williams, Dental Contracts Abertawe Bro Morgannwg University Health Board Kidwelly House,Charter Court,Phoenix Way Llansamlet,Swansea,SA7 9FS Tel/Ffron 01792 784873 [email protected] Bridgend Keir Beard Head of Primary & Community Services Abertawe Bro Morgannwg University Health Board , Bridgend Locality Office / North Court, David Street Bridgend Industrial Estate, Bridgend, CF31 3TP Tel / Ffon: 01656 754400 [email protected] Neath Port Talbot Kimberly Dunn Primary Care Development Manager NPT Locality, Suite A Britannic House,Llandarcy Neath, SA10 6JQ Tel: 01792 326500

of 14 K [email protected] POWYS TEACHING LHB Powys Stephen Hawker Primary care contracts manager, Powys LHB Mansion House, Bronllys, Brecon LD3 0LS 01874712633 [email protected]

. CARDIFF AND VALE UNIVERSITY LHB Cardiff and Vale David Oliver of Glamorgan Primary Care Dental Lead Cardiff and Vale University LHB Trenewydd, Fairwater Road, Llandaff, Cardiff CF5 2LD 029 2055 6013 [email protected] CWM TAF LHB Rhondda Cynon Allison Green Taff and Primary Care Development Manager Merthyr Tydfil Cwm Taf Local Health Board Unit 3 Navigation Park, Abercynon, CF45 4SN 01443 744904 [email protected] ANEURIN BEVAN LHB Monmouthshire Ruth Churchill Interim Head of Primary Care Aneurin Bevan Health Board - Monmouthshire Locality Office Singleton Court Business Park, Wonastow Rd, Monmouth , NP25 5JA Direct Line 01600 710039 [email protected] Newport Emma Procter Head of Primary Care for Newport Locality 138-140 Corporation Road, Newport, NP19 0BH Tel/Ffon: 01633 261430 [email protected] Caerphilly Nigel W. Edwards M.Sc,Cms,Mihm Service Development Manager - Primary Care Caerphilly Locality Office Llanarth House,Unit 1 Newbridge Gateway,Bridge Street, NewbridgeNP11 5GH Office:01495 241246 Email:[email protected] Torfaen Paul Richards Head of Primary Care Mamhilad House, Mamhilad Park Estate, Pontypool, NP4 0YP Tel/Ffon: 01495 332187 [email protected]

Blaenau Gwent Linda Davenport Aneurin Bevan Health Board Anvil Court, Church Street, Abertillery, NP13 1DB

of 14 Tel/Ffon: 01495 325430 [email protected] HYWEL DDA LHB Pembrokeshire Amanda Whiting and Ceredigion Hywel Dda Local Health Board Merlins Court, Winch Lane, Haverfordwest SA61 1SB Tel/Ffon 01437 771220 [email protected] Carmarthenshire Rhian Bond Hywel Dda LHB Unit 5 , Parc Dafen, Heol Cropin, Llanelli SA14 8QW Tel/Ffron 01554 744400 [email protected]

of 14 Appendix 2

MEMORANDUM OF UNDERSTANDING FOR THE WELSH DENTAL PILOT PROGRAMME

Between

The Welsh Dental Pilot Programme, Public Health Wales & [Insert LHB Name] and [Insert Provider Name]

------I. DOCUMENT PURPOSE AND STATUS

This is an agreement between “The Welsh Dental Pilot Programme, Public Health Wales”, hereinafter called “The Programme” (Party A) and [Insert name of LHB and Provider] (Parties B and C).

The purpose of this document is to outline clearly the ways of working and the roles and responsibilities of participants involved in the Welsh Dental Pilot Programme.

Whilst the contract, which has been put forward for inclusion in Welsh Dental Pilot Programme is a legally binding document between the LHB and Provider, and remains the responsibility of these two parties, this document is not legally binding.

II. DURATION

These requirements will last for XX months, (i.e. XX years), will begin on XXX 2011 and will end on XXXXX 2013

III. BACKGROUND

The Welsh Dental Pilot Programmes overarching aim is to ensure that the NHS dental service moves from a service focused on treatment to one that is a dental health service.

The Programme plans to develop a range of different contract models to pilot in order to determine the most effective ways to drive oral-health focused clinical practice.

of 14 Based on the recommendations made by the UDA sub group, it is clear that a significant range of contract options exist. The Welsh Dental Pilot Programme is currently in the process of determining the most suitable models to pilot. The aim of the Welsh Dental Pilot Programme is therefore:

 To learn from existing innovative practice being undertaken by commissioners and providers throughout the country  To capture any existing good practice which will inform the operational working of the Welsh Dental Pilot Programme Pilots  To facilitate early analysis and learning of current working arrangements and novel working practices.

IV. RESPONSIBILITIES OF WELSH DENTAL PILOT PROGRAMME PARTICIPANTS

In agreeing to be part of the Welsh Dental Pilot Programme, participants are agreeing to the following commitments:

 LHBs will provide the Welsh Dental Pilot Programme with a copy of the contract and any supporting documentation they are proposing to be part of the Welsh Dental Pilot Programme no later than XXXXXXX.

 LHBs will provide the Welsh Dental Pilot Programme with a copy of all data they are collecting to monitor contract performance. The Programme will discuss the required frequency of data submissions with both the Provider and the LHB, and a mutually agreeable reporting cycle will be agreed no later than the end of XXXX.

 Providers and LHBs may be asked to collect additional data items at a later date. The Programme will discuss the feasibility and reasonableness of collecting additional data items in advance of a formal request being made. Where possible, sites should endeavour to collect the additional data items requested by the Programme.

 Providers and LHBs will be willing to participate in evaluation activities being carried out by the Welsh Dental Pilot Programme. This may include participating in interviews, conducting dip sampling and providing evaluators with further explanation about contract arrangements. It is worth noting that evaluation will focus on pragmatically evaluating the service, rather than being an academic research randomised controlled trial.

 LHBs will inform the central Programme Team of any significant contractual changes or any major changes that may significantly affect the performance of the LHB or Provider involved in the Pilot. Changes may have an impact on monitoring arrangements and on data that is being collected which may subsequently result in a less robust evaluation process. Thus, it is important that any changes made to the contract (which has been put forward to participate in the Welsh Dental Pilot Programme), are communicated as soon as possible.

of 14  Providers and LHBs must be willing to provide honest feedback and share experiences and learning about their contract models and more specifically on explaining how contracts have influenced their own behaviours, their patients’ behaviours and their performance against quality indicators.

V. GOVERNANCE AND REVIEW

A member of the Welsh Dental Pilot Programme Team, the LHB and Provider will review the requirements contained within this document every year on XXXX .

If any party wishes to amend the requirements outlined in this document, the other parties must be consulted and in agreement with the proposed changes.

If either the Provider or LHB wishes to withdraw from the Welsh Dental Pilot Programme, the party wishing to withdraw should inform the other party of the intention to withdraw and the reasons for this request. The Programme would encourage both parties to discuss the intention and reasons for withdrawal prior to informing the Programme.

Once both parties have been able to discuss the reasons for the withdrawal, the LHB should communicate the contractor’s decision to withdraw, the date of that decision and the reasons for the request to withdraw, in writing, to the Programme Director. The Programme Director will work with the Provider and LHB in question to ensure that issues involved in participating in the Welsh Dental Pilot Programme have been resolved and that participation in the Pioneer Wave is concluded as easily as possible.

If the Provider or LHB is unable to comply with the requirements outlined in this document, they should communicate this to the Programme Team at the earliest opportunity. Repeated failure to comply with the terms of this memorandum may lead to the Provider and LHB in question no longer being recognised as a “Welsh Dental Pilot”.

VI. EFFECTIVE DATE AND SIGNATURE

This memorandum of understanding will be effective upon the signature of the Welsh Dental Pilot Programme Director (Party A), the LHB Director with responsibility for Dental Commissioning (Party B) and the Dental Provider with whom the contract is held (Party C).

Parties A, B and C indicate agreement with this memorandum of understanding by their signatures. These requirements shall be in force from XXXXXXX to XXXXXXXXX.

Signatures and dates

[insert name of Party A] [insert name of Party B] [insert name Party C]

of 14 ______

of 14 Appendix 3